Show me the science (studies) that proves keto is healthy for our cardiovascular systems

#1

I have approached this from the opposite angle and provided studies that show it is bad. However I have yet to find any studies proving the opposite.

Could someone please provide studies that show that the ketogenic diet is healthy for the cardiovascular system? In particular that it does not cause arterial stiffening or plaque build up?

I have found nothing but good things about the diet in personal experience. I call it the Benjamin Button diet as people guess my age at 5-10 years younger than I am, whereas before the diet they usually guessed spot on. However I want to see the science proving what I am asking about above rather than just going on personal experience.

(VLC.MD) #2

Did you read this thread ?

#3

Thank you, yes I just did. It references studies, but, from what I could tell, they do not specify anything that would directly counter the idea that keto may cause arterial stiffening and/or plaque build up in arteries. From what I know of those and other studies, cardiovascular health is deemed to improve on a ketogenic diet but they are only going off of markers like cholesterol count and such things and not actually checking to see whether or not the arteries themselves are in good health.

I have found one study (linked below) where they actually checked the participants arteries and they had stiffened.

I am therefore looking for a study or studies that show the opposite to be true, or at least that show no stiffening or plaque build up.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325592/

(John) #4

There is not likely to be much out there, this ‘diet’ is relatively new in non-epileptic populations and there is no real incentive to ‘prove’ something like this. Studies often get funded by people with an agenda, there are profits in saying keto causes a rise in LDL and statins reduce LDL, there is no money in saying a diet is healthy or that it doesn’t clog arteries.

There is nothing really ‘damning’ in the one you listed.

43 children ages 2–15 years were started on dietary therapy; 84% on a standard 4:1 ratio ketogenic diet. They all had carotid ultrasounds at baseline, 3, 12, and 24 months, along with fasting serum lipid profiles. The carotid arteries were less “distensible” at 3 and 12 months but returned to normal by 24 months, and there was no difference in the intimal wall thickness. Although one might suspect the distensibility would be correlated to total cholesterol or triglycerides, there was no statistical relationship identified.

So there was a little stiffening at the start but then all signs went away, and it was not correlated with cholesterol or triglycerides. In other words, we don’t know why but it isn’t cholesterol. I would be curious to know what caused the initial stiffening, but if there is no money in it, it won’t get funded and we won’t know, or a group has done the study and it doesn’t fit what they want so they don’t publish it.

They point blank shoot down the heart attack scenario

It is not unusual for a family to ask: “ will my child have a heart attack from this diet?” Preliminary data suggests that although serum lipid values increase in the first several months on the ketogenic diet, they decline to normal values by 12 months and remain normal on the diet for many years (4, 5). Long-term follow-up of children off the ketogenic diet (now often young adults) has not demonstrated any obvious cardiovascular issues

So serum lipids go up, but we already know from the first statement that it doesn’t mean anything, then it goes to normal for “many years”. Also long-term shows no cardiovascular issues. You can tell by the wording that this group has a bias against cholesterol, they don’t mention it anywhere in their conclusions, but several times throughout the rest of the study. When the question is “will my child have a heart attack?” their response is simply serum lipids go up but then come down, which means it is the first and in this case the only thing they looked at.

#5

@jmbundy hank you! You make a lot of sense. My only question is; does the return to normal only apply to people who have quit the ketogenic diet and returned to a non ketogenic diet?

The Kapetanakis study says that they “returned to normal by 24 months”. Does this mean that they were still on the ketogenic diet and returned to normal or that they had quit?

The Coppola study mentioned says: “Results were highly similar: those patients treated with dietary therapy had decreased carotid distensibility but no change in the actual artery thickness. In addition, those who had stopped the ketogenic diet in the more distant past (defined as >3 years) had a return to normal values.”

So does it return to normal on it’s own, despite continuing to be on a ketogenic diet? Or does it only return to normal for those who quit the diet?

(John) #6

So these are 2 studies, addressing the second one quickly their methodology was

We evaluated 26 children after one year and 13 children after two years of ketogenic diet…These differences were not significant at 24 months.

So this was a group that was monitored from beginning to 24 months, there were effects early but none after 2 years.

The first study is just an observational study and we shouldn’t try to draw a lot of conclusions from it. It measures a single point in time:

Unlike the study from Sweden, this study examined only carotid artery function at one time point

This study found kids with epilepsy who were treated with the ketogenic diet, and then went looking for a group that had:

drug resistant epilepsy, matched for number, age and sex and never treated with ketogenic diet

Some problems here, the first group had some people that were still on it, and some that hadn’t been on it in years. This is where your stiffness but not thickness came from and the fact that it returned to normal in cases where they stopped 3 years prior. This makes it sound like there will be stiffness if you are on it, but if you stop then you will go back to normal, but the other study said you will go back to normal whether you stop or not.

So if we ignore those that quit and we are left with those that have done keto and those that have not, we still have some confounders. Why would a group choose to do keto, or not to? We know nothing about why some were treated and some were not. I have a hard time imagining someone having constant seizures choosing not to use a nearly 100 year old, easy and effective treatment. I don’t personally know, but a quick search finds some people have 1 or 2 seizures a month, some once every 6 months, and some mentioned 20-50 per day. I would imagine a person having 20-50 a day would be much more likely to be on a ketogenic diet than someone that has a couple per year. Looking into when it is recommended I see this:

It is particularly recommended for children with the Lennox-Gastaut syndrome.

This is the problem, the only thing they are comparing are people having drug resistant seizures, not any of the other things going on that could affect things.

At the end of the day the only thing I see is that there is some corroboration between 2 small studies that suggest the early stages of a ketogenic diet has some arterial stiffening with an unknown cause and resolution that goes away over time while having no effect at all on arterial thickness. Should arterial stiffness be found to be a concern, these studies show that a break from the diet will return everything to normal.

(Sjur Gjøstein Karevoll) #7

Another thing worth pointing out is that the classical ketogenic diets are not exactly composed of whole foods. If you’re eating 2000 calories on the 4:1 diet you’re limited to 50g of carbs and protein combined. Even if that’s all protein you’re not getting enough and would likely suffer from at least a mile deficiency. With carbs and protein that restricted you’re also reducing your food diversity by a lot and cutting out a wide swath of highly nutritious foods. A lot of the best fats like butter, suet and avocado also contains a small number of carbs and protein, so instead vegetable oils have been used. It’s not surprising that many of the dangers of a ketogenic diet have been found in studies observing people on these kinds of diet, not in people on a well formulated modified ketogenic diet that allows for much higher protein, more carbs and has a focus on whole foods.

(Duncan Kerridge) #8

Not exactly what you’re looking for but this study examines whether a diet higher in saturated fat increases arterial stiffness

TLDR - it doesn’t

#9

@jmbundy

Thank you so much for your well written and helpful post!

#10

@jmbundy

Sorry to ask in an old thread but I figured it was better than starting a new one.

What is your opinion on what causes the arterial stiffening?

Normally it is plaque that causes this, but I don’t imagine plaque popping up like that and disappearing for no reason as it must if the arteries returned to normal after two years.

And, if it resolves itself over time, what about when we eat too many carbs a few days in a row and drop out of ketosis and then get back in? Does the process start all over again and we would have stiffened arteries for two years, every single time we go in and out of ketosis?

(John) #11

No clue. In my rational mind, which may not be accurate at all, I think we have to think about 3 options.

  1. Something happens when you go on ketosis that doesn’t exist later. There are things that happen like gut microbe changes and all of those sorts of things, but something like this seems unlikely to me over the long time frame. Almost everything in our body is recycled several times over the course of a year, so what would would still cause problems at 12 months but not at 18?

  2. Maybe there is something like an allergic reaction, a defense mechanism that for most takes quite some time to overcome. Recent evidence seems to show that even things like peanut allergies are overcome by a lot of people over time. These studies are small, so maybe some never recover.

  3. This is something related to underlying causes of the conditions that are leaving them with seizures (all of these studies seem to be in children with confounding problems already).

Quote from Wiki

There has also been noted a correspondence between higher triglyceride levels and higher levels of smaller, denser LDL particles and alternately lower triglyceride levels and higher levels of the larger, less dense (a.k.a. “buoyant”) LDL.

We know that trigs are high when carbs are high, and we also know that LDL goes up on keto. Trigs generally come down and LDL usually becomes big and fluffy. In the meantime maybe we have this perfect storm of badness, trigs are still high from our old diet (mine took >12 months to come down fully) while LDL is increasing and creating a lot of stiffening and inflammation. Over time our trigs come down a lot and our LDL and HDL do what they are supposed to and the world is happy. Nothing ever seems simple with our body so I find it hard to believe that in something so complex there could be one simple cause that is easily fixed that cures everything.

#12

@jmbundy

Thank you and I appreciate your patience and sharing your knowledge.

Could you clarify number 2? Who are you referring to when you said “so maybe some never recover.”? People with peanut allergies or people with ketosis induced arterial stiffness? If the ketosis people, the study showed that everyone recovered (went back to normal) right? So why would we assume that some never recover any more than we would assume that all that recovered in the study had a complete return to arterial stiffness after the study concluded? Neither assumptions are supported by the data in the study.

Further, what in the world does this particular arterial stiffness do anyway? One would assume it would make heart attacks more likely. However none of the people in the study had one and I don’t know of any ketosis studies that have participants having heart attacks. So is this some kind of benign arterial stiffness that is unrelated to the common arterial stiffness that is associated with heart attacks?

In particular what comes to mind are all the people who start keto and after a few months are running marathons and other such feats of stamina. If they had heart disease related arterial stiffening then a lot of them would have heart attacks. Yet this does not seem to happen despite the fact that, if this study is applicable to all, they must all have this ketosis induced arterial stiffening. What gives?

(Bacon is a many-splendoured thing) #13

The role of cholesterol in cardiac health has been greatly distorted. Firstly, our veins and arteries are made primarily of cholesterol, so without it, we’d really be up the creek.

Secondly, cholesterol is part of the repair process when a section of artery becomes inflamed. Assuming that the presence of cholesterol in arterial plaque means that the cholesterol caused the plaque is like assuming that, because we always see police at a crime scene, getting rid of the police will stop the crime.

Dr. Phinney’s explanation of the risk of small, dense HDL is simply that it’s more vulnerable to oxidation, which can lead to trouble from the oxidized particles. Moreover, if these particles are too badly damaged, the body’s cleanup mechanisms can fail to recognize them. Dr. Diamond’s take is that the problem is not the cholesterol per se, but the lipoproteins in which the cholesterol is transported. He says that certain types are more easily damaged and can cause more damage than others.

#14

@PaulL

I am fine with cholesterol. I am reading “The Great Cholesterol Myth” right now.

What I am concerned about is the arterial stiffening reported by a study.

(John) #15

I just mean that with such a small population and few studies that we can’t say everyone always will recover. Looking out my window right now I don’t see any black cars, that doesn’t mean there aren’t any, my sample size is just too small to confirm or deny their existence.

As far as the arterial stiffness/heart attack link I haven’t seen anything that shows causation. With as many people as have started the keto diet over the years, and the fact that this stiffness lasts more than a year, you would indeed think people would start noticing a trend toward people having cardiac events during the first year.

#16

@jmbundy

Thanks. And exactly and we are not seeing this. So is the study and others like it flawed or falsified in some way? It is really puzzling!

(Bacon is a many-splendoured thing) #17

It’s more likely to be flawed than falsified, but who knows?

#18

@PaulL

Agreed but seriously. According to this study EVERY participant developed stiffened arteries, yet none died of heart attacks.

Apply this to all of us ketoers and we have millions of people with stiffened arteries and no reports of heart attacks left and right, which one would expect if every single person who got on keto immediately developed stiffened arteries. So what gives?

(Doug) #19